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Huge lesion : purulent drainage

From: Mark Dreyer To: ROOTS Sent: Saturday, July 26, 2008 2:05 AM Subject: [roots] Huge lesion I tx planned this case a year ago. The guy didn't schedule for tx until a month ago when his face was swollen like a balloon. Initial visit we did the cleaning shaping, noted tons of purulent drainage. Also did I&D and got another ton of drainage. Today all swelling and symptoms had resolved so we packed the case. There were no obvious signs of fx nor any probing defects so I'm quite optimistic this will heal and look forward to hopefully getting him back for recalls. I know some endodontists don't pack a case like this till they see radiographic evidence of healing 3-6 months later. I can see the value of this if the tooth was a critical abutment for a multi unit bridge for instance, (not wanting the gp to go ahead with an expensive restorative plan utilizing a tooth like this until it looks like things are healing) but in a single tooth situation like this, especially with a patient that has demonstrated a previous lack of compliance with tx recommendations, I think it's best to get the case finished asap. -- Mark Dreyer

I see your wisdom Dr Mark. Better to have the RCfill before the patient does another disappearing act. I follow the same protocol. Risky, but compared to the risk of the patient disappearing with your temp and turning up with a bigger mess, I choose the risk of doing the RCFills on my lazy patients on the same day - Sanjay Sanjay, I probably should have just taken the bull by the horns and done the buildup also because of the same rationale, but I've found doing that sort of thing doesn't set well with referring docs, and I still have two expensive teenagers to support. :-)) - Mark Mark, After thorough debridement and disinfection, root filling after a few weeks is appropriate. Waiting 12 weeks to see some healing is beneficial in the long run, IMHO, for long-term treatment planning. Nice case! - Fred

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